Provider Demographics
NPI:1760735310
Name:UNIVITA HOME HEALTH ASSESSMENTS OF OHIO LLC
Entity Type:Organization
Organization Name:UNIVITA HOME HEALTH ASSESSMENTS OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ENGAGEMENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-922-8942
Mailing Address - Street 1:11000 PRAIRIE LAKES DRIVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-456-4875
Mailing Address - Fax:952-833-5489
Practice Address - Street 1:11000 PRAIRIE LAKES DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-456-4875
Practice Address - Fax:952-833-5489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVITA HEALTHCARE SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty